All-cause Mortality Associated with TNF-α Inhibitors in Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE: To compare mortality data obtained from randomized controlled trials for the 5 tumor necrosis factor-alpha (TNF-alpha) inhibitors used in the treatment of rheumatoid arthritis. METHODS: A systematic review of articles published up to November 2014 was performed using electronic databases. We included randomized, controlled trials, with a follow-up period of at least 24 weeks, comparing TNF-alpha inhibitors to placebo or disease-modifying antirheumatic drugs. The primary outcome was the occurrence of all-cause mortality. RESULTS: Twenty-three studies were selected. These articles included 6525 patients in the anti-TNF-alpha group and 3523 in the control group. The duration of patient follow-up ranged from 24 to 104 weeks. The risk of all-cause mortality in patients receiving TNF-alpha inhibitors was not significantly different from those receiving the comparator (odds ratio 1.32; 95% confidence interval, 0.76-2.29). Subgroup analyses with respect to the molecule used, the dose received, the use of TNF-alpha inhibitors as monotherapy or combination therapy, or the quality of the trial did not modify the findings. CONCLUSION: This meta-analysis performed on a large number of patients and including the 5 TNF-alpha inhibitors currently available shows no increased risk of medium-term all-cause mortality in patients with rheumatoid arthritis. (C) 2015 Elsevier Inc. All rights reserved.